What a manual payment review is
A manual payment review is when we check claims made by a provider or participant before they’re paid.
These reviews mostly apply to providers, but sometimes we do these reviews for participant claims too.
What a manual payment review is for
We may do a manual payment review if we have concerns about how NDIS funds have been used.
Under the NDIS laws, there are things we can’t fund or provide. NDIS funds can only be used for items listed as NDIS supports.
We might need to contact a provider, or a participant or their nominee, to make sure the claim:
- is for NDIS supports
- is included as part of a participant’s NDIS plan
- was delivered like it says in the claim.
What a manual payment review is like
While the claim is under review, payments will be stopped until we:
- receive and assess the supporting evidence
- make a decision about whether to pay the claim.
We’ll ask for all records and evidence about claims under review, so keeping good records is very important.
We let you know you if we are reviewing a claim
We’ll tell you why this review is happening and the next steps.
We let you know what information we need to support a claim
We’ll tell you what information or evidence we need and how to give this to us.
For example, we might ask you to show that the:
- claim is for a NDIS support
- claim is in line with a participant’s plan
- claim is not a duplicate claim
- claim is for a service that was delivered
- person making the claim is legally allowed the claimed amount.
We give you more time to provide any more information or comments based on our initial decision
If we think the information provided wasn't enough to support the claim, we’ll tell you the reasons why in a letter.
We’ll then give you a further 14 days to respond and give us further information.
We make a final decision if the claim will be paid or remain unpaid
We’ll review more information or comments given to us, if relevant, and come to a final decision on whether the claim will be paid or remain unpaid.
We’ll tell you about this outcome in a letter. We’ll pay claims that have enough information and evidence.